Impact of Double- or Triple-Hit Pathology on Rates and Durability of Radiation Therapy Response Among Patients With Relapsed or Refractory Large B-Cell Lymphoma

Kim, Aileen; Stevenson, Philip A.; Cassaday, Ryan D.; Soma, Lori; Fromm, Jonathan R.; Gopal, Ajay K.; Smith, Stephen D.; Till, Brian G.; Lynch, Ryan C.; Ujjani, Chaitra S.; Shadman, Mazyar; Warren, Edus H.; Menon, Manoj; Russell, Kenneth J.; Tseng, Yolanda D.

doi:10.1016/j.prro.2019.09.013

Cited by 14 publications

(5 citation statements)

References 36 publications

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“…32 Adequate initial treatment for these high-grade histologies is essential, given poorer oncologic outcomes after relapse. 33 In a retrospective multi-center study, which looked at outcomes of limited-stage B-Cell lymphoma that harbor MYC with or without BCL2 and BCL6 translocations (not all HGBCL by WHO definition), PFS and OS were similar in patients receiving involved field radiotherapy (IFRT) vs. no IFRT, and R-CHOP vs. intensive immunochemotherapy. 21 Complete response rates, however were higher in patients receiving IFRT (98% vs 72%; p < .001).…”

Section: Discussionmentioning

confidence: 99%

R-CHOP and Consolidation Radiotherapy for Limitedstage and Low-IPI High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 rearrangements: a Single-center Case Series and Review of Literature

2024

Acta Med Philipp

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High-Grade B-Cell Lymphoma (HGBCL) with gene rearrangements in MYC and BCL2 and/or BCL6 is an aggressive malignancy usually presenting in advanced stages. Current recommendations suggest the use of regimens more intensive than R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone), which are based on retrospective studies and single-arm prospective trials that included patients who are mostly in the advanced stage, and did not receive consolidation radiotherapy.The optimal approach and treatment of HGBCL, whether limited-stage (LS) or advanced-stage, remains to be determined. Here we describe the promising outcomes of three patients with LS and low IPI HGBCL with the use of R-CHOP as induction chemotherapy regimen, which was followed by consolidation radiotherapy.Three women, 54-, 60-, and 64-years of age diagnosed to have HGBCL with MYC, and BCL2 and/or BCL6 rearrangements, with Ann Arbor stages I-IIE were included in this case series. All three patients had complete metabolic response to 6 cycles of R-CHOP and was subsequently treated with consolidation involved site radiotherapy (ISRT; total dose 30-36 Gy). Chemotherapy and radiotherapy were tolerated very well. All patients remain to be in remission, with the longest being at 23 months.Outcomes of patients with HGBCL generally remain to be poor, but this may not be the case for patients with limited-stage disease and favorable clinicopathologic risk profile. Nevertheless, the treatment of HGBCL is currently evolving and more studies are needed to determine the ideal approach and preferred chemotherapy regimen. Also, more studies are needed to elucidate the potential role of consolidation radiotherapy in patients with limited-stage HGBCL to improve survival outcomes. Findings of this case series suggest that patients with LS HGBCL may still derive benefit from R-CHOP followed by consolidation ISRT, but prospective trials are needed to confirm this.

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Section: Discussionmentioning

confidence: 99%

R-CHOP and Consolidation Radiotherapy for Limitedstage and Low-IPI High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 rearrangements: a Single-center Case Series and Review of Literature

2024

Acta Med Philipp

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“…Whether higher palliative doses may be necessary for bulky disease or lymphomas with particular immunophenotypic or genetic features remains to be characterized. 22 , 23 , 24 , 25 A larger multi-institutional review is currently underway to further investigate the association between gene rearrangements or overexpression and radiosensitivity.…”

Section: Discussionmentioning

confidence: 99%

Radiation Therapy for Relapsed or Refractory Diffuse Large B-Cell Lymphoma: What Is the Right Regimen for Palliation?

Wright

Dreyfuss

Baron

et al. 2022

Advances in Radiation Oncology

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“…These include bulky tumors, Myc with BCL2 and/or BCL6 rearrangements and high MTV. 34,[40][41][42] 3.4 | BRT may prime the immune system and sensitize CART cells RT has the potential to sensitize solid tumors to immunotherapy/ cellular therapy 43,44 as well as provoking an abscopal-like effect to CART. 45,46 This suggests its ability to enhance CART-cell activity.…”

Section: Brt Improves Local Control and May Alter The Pattern Of Rela...mentioning

confidence: 99%

“…Certain risk factors predict for increased risk of RT‐infield failure and may warrant BRT dose escalation. These include bulky tumors, Myc with BCL2 and/or BCL6 rearrangements and high MTV 34,40–42 …”

Section: Radiation As a Bridging Therapy Prior To Cartmentioning

confidence: 99%

Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

Saifi,

Lester,

Breen

et al. 2023

American J Hematol

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Anti‐CD19 chimeric antigen receptor T‐cell therapy (CART) has revolutionized the outcomes of relapsed and/or refractory B‐cell non‐Hodgkin lymphoma. However, CART is still limited by its availability, toxicity, and response durability. Not all patients make it to the CART infusion phase due to disease progression. Among those who receive CART, a significant number of patients experience life‐threatening cytokine release syndrome toxicity, and less than half maintain a durable response with the majority relapsing in pre‐existing sites of disease present pre‐CART. Radiation therapy stands as a promising peri‐CART and salvage treatment that can improve the outcomes of these patients. Evidence suggests that bridging radiotherapy prior to CART controls the disease during the manufacturing period, augments response rates and local control, cytoreduces/debulks the disease and decreases the severity of cytokine release syndrome, and may prolong disease‐free intervals and survival especially in patients with bulky disease. Consolidative radiotherapy for residual post‐CART disease alters the pattern of relapse and improves local recurrence‐free and progression‐free survivals. Salvage radiotherapy for relapsed post‐CART disease has favorable survival outcomes when delivered comprehensively for patients with limited relapsed disease and palliates symptoms for patients with diffuse relapsed disease. The biology of the disease during the peri‐CART period is poorly understood, and further studies investigating the optimal timing and dosing of radiation therapy (RT) are needed. In this review, we tackle the most significant challenges of CART, review and propose how RT can help mitigate these challenges, and provide The Mayo Clinic experts' approach on incorporating RT with CART.

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Impact of Double- or Triple-Hit Pathology on Rates and Durability of Radiation Therapy Response Among Patients With Relapsed or Refractory Large B-Cell Lymphoma

Cited by 14 publications

References 36 publications

R-CHOP and Consolidation Radiotherapy for Limitedstage and Low-IPI High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 rearrangements: a Single-center Case Series and Review of Literature

R-CHOP and Consolidation Radiotherapy for Limitedstage and Low-IPI High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 rearrangements: a Single-center Case Series and Review of Literature

Radiation Therapy for Relapsed or Refractory Diffuse Large B-Cell Lymphoma: What Is the Right Regimen for Palliation?

Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

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